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COMMENTARY Open Access

People-centred science: strengthening thepractice of health policy and systems researchKabir Sheikh1, Asha George2* and Lucy Gilson3

Abstract

Health policy and systems research (HPSR) is a transdisciplinary field of global importance, with its own emergingstandards for creating, evaluating, and utilizing knowledge, and distinguished by a particular orientation towardsinfluencing policy and wider action to strengthen health systems. In this commentary, we argue that the abilityof the HPSR field to influence real world change hinges on its becoming more people-centred. We seepeople-centredness as recognizing the field of enquiry as one of social construction, requiring those conductingHPSR to locate their own position in the system, and conduct and publish research in a manner that foregroundshuman agency attributes and values, and is acutely attentive to policy context. Change occurs at many layers of ahealth system, shaped by social, political, and economic forces, and brought about by different groups of peoplewho make up the system, including service users and communities. The seeds of transformative practice in HPSRlie in amplifying the breadth and depth of dialogue across health system actors in the conduct of research –recognizing that these actors are all generators, sources, and users of knowledge about the system. While buildingsuch a dialogic practice, those conducting HPSR must strive to protect the autonomy and integrity of their ideasand actions, and also clearly explain their own positions and the value-basis of their work. We conclude with a setof questions that health policy and systems researchers may wish to consider in making their practice morepeople-centred, and hence more oriented toward real-world change.

Keywords: Context, Dialogue, Health policy and systems research, Health systems research, Knowledge translation,People-centred health systems, Reflexivity, Research practice, Social construction

Health policy and systems research: achange-generating fieldHealth policy and systems research (HPSR) is widelyrecognised as a critical element of the action needed toachieve the health-focused Millennium DevelopmentGoals, strengthen primary health care, and promote uni-versal health coverage [1]. Focussed on generating know-ledge on how best to organize collective responses topromoting health and tackling disease over time, this re-search field studies international, national, subnational,and local health systems and their interlinkages, as wellas policies made and implemented at all levels of thehealth system. In 2012, the successful 2nd Global HealthSystems Research Symposium, and the formation of aHealth Systems Research society, drew a large community

* Correspondence: ageorg22@jhu.edu2Johns Hopkins University Bloomberg School of Public Health, 615 NorthWolfe Street, Suite E-8146, Baltimore, MD 21205, USAFull list of author information is available at the end of the article

© 2014 Sheikh et al.; licensee BioMed CentralCommons Attribution License (http://creativecreproduction in any medium, provided the orDedication waiver (http://creativecommons.orunless otherwise stated.

of interested groups together not only to examine theavailable research knowledge but also to work towards de-veloping and strengthening the practice and approach ofthe research conducted. Publication of the 2012 WHOHPSR strategy also sought to contribute to this latter goalby supporting the development of an identity for the fieldof work, with ‘its own standards for evaluating evidence,assembling knowledge, and translating it into recommen-dations that decision makers in the health system cancomprehend, trust, and implement’ [2], p. 15. In 2014, thisresearch and policy community will meet in South Africato discuss ‘The Science and Practice of People-centredHealth Systems’, the theme of this year’s Global Sympo-sium on Health Systems Research.There is consensus on some key features of HPSR [3,4].

Focus areas within it include the performance of healthsystems and their subcomponents (resources, organiza-tions, and services), as well as consideration of how linksamong the subcomponents shape performance, what

Ltd. This is an Open Access article distributed under the terms of the Creativeommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andiginal work is properly credited. The Creative Commons Public Domaing/publicdomain/zero/1.0/) applies to the data made available in this article,

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forces influence those links, and how to strengthen healthsystem performance over time. HPSR is also recognized asa hybrid, or ‘trans-disciplinary’ field, drawing on differentdisciplinary traditions and methodological approaches,and with links back to the older field of health services re-search. Most critically, HPSR is applied research, under-taken with an orientation towards influencing policy andwider action to improve the performance of health sys-tems, in the short or long term.However, as those who work in this field come from

different knowledge traditions, these differences con-tinue to influence how they view health systems andhow they approach knowledge generation and evalu-ation. In line with prior arguments [5-7], we seek in thiscommentary to elaborate directions for the practice ofHPSR founded on the particular understanding that i)health systems are social and political constructs that, aspart of the fabric of any society, provide vital opportun-ities for tackling social injustice; ii) human agency, ininteraction with broader societal structures, fundamen-tally shapes health systems; and iii) social science per-spectives and approaches offer particular value to thisarea of trans-disciplinary research. As authors, we comefrom eclectic backgrounds in public health, health policystudies, health economics, international relations, devel-opment studies, and medicine, with experience of HPSRmostly from India and sub-Saharan Africa. From thesevarious bases, we argue that the potential of HPSR toachieve health system change hinges on it becomingmore people-centred in how it is conceived, conducted,and utilized.System change begins and ends with people because

people, operating in various roles, ultimately make up anysystem and fundamentally shape how it works. Acknow-ledging that health systems are constituted by people andoperate in social, political, and economic contexts definedby people and groups with varying interests and values,opens up a panoply of opportunities to influence andchange them. It also requires researchers to acknowledgeand address questions around their own role and poweras actors in the same system.The following sections both unpack our foundational

understanding and outline directions for the emergenceof such a people-centric practice of HPSR. Using threebrief case studies from our own work, we consider howhealth policy and systems are conceptualised (seeing), aswell as the roles that researchers play within healthpolicy and systems (being) and in the conduct of HPSRitself (doing). We end by outlining questions researchersmight use to deepen these three dimensions of theirpractice. The audience we address are all people engagedin conducting HPSR, working in government, NGO, oruniversity settings with full-time or part-time researchroles, who seek to support change in health policies and

systems so as to improve people’s lives and address so-cial inequalities.

Seeing – systems with people at the coreHealth systems operate in broader contexts that arestrongly influenced by peopleThere is an emerging appreciation of the evidence thatshows that health systems are entrenched in their social,political, and economic settings, responding to healthneeds that themselves are generated by social, political,and economic forces and strongly shaped by the decisionsand actions of historical and current day actors [8-10].Broader contextual influences also seep into the daily prac-tice of a health system through the experiences, mindsets,and values that shape the behaviours of the actors within it[11,12] (see Case study 1). As a result, despite similar ele-ments and patterns, they can respond radically differentlyto the same new idea, policy, or intervention [13]. The dan-gers of HPSR that purports to support context-free andwidely generalizable knowledge is increasingly evident [14],as also shown by the emerging social science-informedperspectives on paying for performance [15,16]. ‘Singletruth’ research findings can distort holistic developmen-tal agendas in low- and middle-income countries anddivert resources towards solutions that are not appro-priate to context, especially when there is very limitedresearch on a particular issue. Fully understanding healthsystems in order to bring change within them thereforerequires that HPSR explicitly accounts for context (Casestudies 1 to 3).

Health systems are constituted by peopleHealth systems have traditionally been conceptualized ininstrumental or functional terms [17,18], but are now in-creasingly understood to have complex and variable at-tributes that are dynamically shaped by human agency atall levels (Case study 1). These include attributes of theso-called hardware of health systems – technical, financial,and material resources – that are shaped and driven byhuman choices and ingenuity; health system software –ideas, interests, values, norms, and relationships; and theinterplay between the software and hardware [5,19]. Associal institutions, it is people who ultimately determinethe character of a health system. Health policy and sys-tems researchers must seek better to understand thesehuman qualities of health systems and policies – and theirvariations as well as similarities across varied settings(Case studies 1 and 2).The people who make up health systems occupy various,

sometimes multiple, positions – as providers, managers,financers, knowledge agents, and users of services. It is im-portant to recognize that all these people are potentialsources as well as users of valuable knowledge about thesystem, often moving between the two roles. Recognizing

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the useful knowledge held by health system actors allowshealth policy and systems researchers to access a greaterbreadth of such knowledge, including practical, moral,and cultural wisdom drawn from lived experiences and ac-cumulated understanding of health system realities [20](Case studies 1 to 3). Equally, people operating in differentlayers of the system (and not only designated policymakers)have diverse capabilities of processing and utilizing know-ledge to bring about systemic improvements [21,22].

Health policies and systems should serve people,especially the most vulnerableInequities in access to material and knowledge resourcesthat improve health, and in the ability to influenceimportant decisions, are a defining feature of healthsystems and policies (as they are of society at large).It is widely established that imbalances of power andsocial injustices underpin disparities in access to healthresources, with particular communities, groups, anddemographic categories in many countries often dis-proportionately experiencing poor health [23]. Anyunderstanding of health systems must embrace anappreciation of power in and across systems and com-munities, and HPSR should have an active intention toaddress equity and social justice [24,25] (Case study 1).Such research should actively recognise the agency andcapabilities of poor and socially marginalized peoplerather than reinforcing a view of them as passive re-cipients of policy.

Case study 1: Ethnographic research on healthworkers in Koppal, southern India. Private providersin poorly regulated health systems are at times seen asunrestrained in their profit-maximising motives, whilegovernment health workers can be characterised withina narrative of demoralisation and/or indifference [26].While both of these depictions are not entirely untrue,they occlude how health workers are also social actorsmaking discerning choices in constrained circumstances,embedded in a myriad of social relationships that influencetheir personal and professional positions within specificpolitical economies. Prolonged immersive ethnographicresearch in Koppal district, southern India, revealedvarious quid-pro-quo bargains struck between frontlinehealth workers, other providers, and the communitiesthey serve. Informal providers negotiated training andreferral with formal providers in both government andprivate sectors, ensuring the filling of vacancies andcontinuity of services, even if at times laced with financialgains. Pressed for economic survival as salesmen in ruralmarkets, they also depended on social ties with commu-nities for their placement, reputation, and protectionfrom the authorities. So while they felt forced to provideinjections and tablets to demonstrate ‘strong’ treatment,

they were at times inhibited from collecting debts fromthe communities they serve [27]. Female auxiliary healthworkers struggled for respect and recognition at variouslevels, starting within their homes. Yet, economicallysecure government positions also enabled them toleverage cooperation from their husbands and otherfamily members. Auxiliary health workers activelysought and succeed at times in negotiating orstalling transfers, disciplinary memos, and otherbureaucratic processes to ensure their interests.Rather than being passive bystanders, they developcoping mechanisms that are self-protective inhierarchical and at times vindictive accountabilitydrives, even if they result in poor patient outcomes.The ethnographic approach, entailing repeatedinteractions over long periods that built trust andfamiliarity, and triangulation of interview datawith observations of everyday events, developed anintimate account of these frontline providers. Itenabled seeing the workers as active social agents,ingeniously navigating complex health systems, andthus provided alternative understandings of how servicedelivery outcomes are realised [27,28]. By creating morenuanced portraits of both positive and negativedimensions of frontline health workers and movingaway from assumptions that either private orgovernment workers are saviours or miscreants,creates the possibility of more informed policyresponses that takes into consideration theseincentives and their socio-political contexts.

Being – locating the researcher in the healthsystemThe researcher in his/her (social, political, and economic)contextAll those engaged in research and analysis on healthpolicy and systems are part of the web of actors andorganisations shaped by social, political, and economicforces that together make up health systems. Theirchoices of themes and questions, the way they approachthem, the way they present research findings, and thepower that they wield (and are, in turn, subjected to) areintegral to the political economy of health policy and sys-tems functioning. ‘Reflexivity’ is the bedrock principle ofHPSR that must guide researchers in acknowledging andqualifying their own choices and positions vis-à-vis theresearch and analysis they undertake, and being explicitabout their own interests, power, and relationships withpolicy processes and determinants of change [29]. In avalue-laden science, explication by the researcher/analystof their philosophical orientation and the broader goalsof their research is also an important part of theirreflexivity.

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The researcher’s relationship with other health systemactorsHealth policy and systems researchers are themselves ac-tors within, and an integral part of, health systems, butin conducting any form of research play a special role inaggregating, synthesising, and analysing available know-ledge. A research practice that targets effective systemicchange, as HPSR does, must be one that entails engage-ment with various actors within the system (Figure 1)(Case study 2) – moving well beyond the oft-invoked ex-hortation of ‘getting research into policy and practice’that implies a schism between the researcher and theresearched, and the worlds of knowledge and practice[30]. The quality and consistency of such engagementamplifies opportunities for the creation of strategic know-ledge about the health system, as well as its uptake andutilization in strengthening health systems [1]. HPSR is al-ways both an act and a product of dialogue, which takesplace over time between those conducting research andother health system actors – with the latter acting formallyas commissioners, collaborators and/or participants in re-search, or less formally as gatekeepers of health system in-formation, informal informants, and brokers and users ofresearch findings [31]. However, a research practice builton interaction and dialogue with stakeholders can raisechallenges for researcher probity, which calls for theevolution of distinct ethical norms and practices forHPSR, with special attention to issues of conflict ofinterest.Engagement with others conducting HPSR is also a key

facet of a dialogic practice, with utility in terms of buildingalliances, and for positioning and fine-tuning research.Membership of a research and practice community offersadded benefits such as opportunities for capacity buildingand peer support and review.

THE HEALTH SYS

Stimulate discourse

Inform policy choices

Reframe debates

Synthesizeanalyze know

KNO

KNOWLEDGE CREATION

Figure 1 Health policy and systems research: a dialogic practice.

Contractor or change-agent?Even as health policy and systems researchers engagewith decision-making it is important that they are notconstrained to act as contracted purveyors of informa-tion to direct seemingly simple policy choices (whetherby government decision-makers or funding agencies)[32]. Health policy and systems researchers have a farbroader, and potentially more transformative role in thesystem, necessitating autonomy in the development ofideas and in practice. They can engage in generatingnew ideas for policy, reframing policy debates to makethem more useful or more ethical, and ensuring thatunder-represented groups are heard [33]. Researcherscan also crucially play a role in policy learning, byengaging with other health system actors directly tosupport them to reflect on and rethink existing prob-lems (Case studies 2 and 3), or indirectly by stimulatingpublic debate and opinion [31]. These transformativeavenues entail varied forms of dialogue with a range ofstakeholders (Figure 1).

Case study 2: District-level action learning and reflec-tive practice in South Africa and Kenya. Governance isoften understood as a function of the formal,organisational centres of a health system (at bothnational and decentralised administration levels). Yetexperiences of policy implementation identify theimportant influence of front line, and informal,governance processes, including communityaccountability, over implementation. In particular, thepractices of health workers and front line managershave an important influence over the trajectory of policychange and health system development [34]. Fullunderstanding of the nature of, influences over, andconsequences of these practices requires engagement

TEM

RESEARCHERS

Promote inclusion of

excluded voices

Promote reflection

and learning

and ledge

WLEDGE UTILIZATION

OTHER HEALTH POLICY / SYSTEM ACTORS

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with the tacit knowledge of these health system actorsand of the social situations and relationships withinwhich they are embedded. A team of South Africanresearchers initiated a long-term process of collaborativeresearch with local health managers in one geographicalarea, based on a reflective practice and action learningapproach [35]. This experience has also informed thedevelopment of two other local level ‘health systemlearning sites’ at district level in South Africa andKenya. These collaborations are allowing inquiry intolocal level governance processes, including leadershipand management practices, priority setting andproblem-solving within primary health care facilities,and managing staff and relationships with actors fromthe community and other sectors. These processes arealso supported in these collaborations as they provideopportunities for local actors, such as primary healthcare facility managers and their supervisors, to reflecton their work, develop new approaches to specific tasks,share and discuss their experience, and adapt and fur-ther develop these approaches. Learning, for exampleabout the leadership and management capabilities neededat primary health care facility and sub-district levels, andabout how to support leadership development at theselevels, is occurring both as a result of more formalprocesses of inquiry and through cycles of collaborative re-flection, action, and learning. This form of researchengagement has provided spaces for trust-buildingbetween researchers and health system actors, andenabled rigorous knowledge generation, whilesimultaneously supporting action for health systemstrengthening.

Doing – people centred research for real-worldchangeIdentifying topics and questions of relevanceThe purpose of HPSR is to create useful knowledge abouthealth policies and systems. Such knowledge includescapturing and explicating the complexity and intercon-nectedness of the various elements [36] in a way that hasmeaning to the people who make up the system and whocan bring about appropriate systemic changes in differentsocial contexts [37]. Such people include not only those atthe upper echelons of power in their respective health sys-tems, but also those at intermediary levels, care providers,users of services, and communities [21,22] (Case study 1and 2). Close and consistent engagement with health sys-tem actors at different levels can enhance the relevance ofHPSR topics and questions, and also the likelihood of useof the findings [38] (Case study 2).

Conducting research of high qualitySince HPSR involves the use of methodologies that drawfrom different disciplines and knowledge paradigms,

yardsticks and standards for research conduct vary inaccordance with the methodology being applied [6,38].Whilst statistical generalizability may be the gold stan-dard for assessing the validity of claims drawn fromquasi-experimental studies, analytic generalizability isthe yardstick for case study research. However, qualityin HPSR is a concern not only in applying the appro-priate methodological rules to guide data collection andanalysis, but at every step in the research endeavour – itis a holistic concern, ranging from how research ques-tions are framed to address real-world concerns, tomatching the question with the appropriate researchapproach and methodology, adapting methodology inresponse to real world realities, and the interpretationand utilization of research findings. Such quality isnot necessarily (or solely) achieved by solitary thinking.In HPSR, as a dialogic science, quality is instead drivenby engagement, contextualization, closeness to opera-tional reality, attention to relevance, and reflexivity andthe values that drive research practice [31]. Researchquestions need to be assessed to judge if they addressissues that are relevant to the people and organisationstrying to bring about positive change in systems (Casestudy 2). Too frequently, methodologies are matchedwith research questions without consideration of fit orappropriateness (as when structured survey instrumentsare the sole approach used to assess how health systemactors understand particular experiences). Furthermore,as discussed earlier, context-free interpretation or ap-plication of research findings carries grave risks anddangers, and hence must also be regarded as an issueof quality.

Policy-mindedness in research outputsPolicy-mindedness is a crucial attribute for healthpolicy and systems researchers. They should notjust aim to present information and evidence, butalso to frame and situate findings and recommenda-tions in actionable, rather than generic terms. Whatis actionable is subject to political viability, context-ual appropriateness, and prevailing balances of policypriorities both within and outside the health sector(Case study 3). HPSR can only be enriched if re-searchers, regardless of which disciplinary frameworkthey have applied, are attentive to the relevance oftheir findings for health and social policy in a givensetting, as well as to the broader social and politicalcontexts to which they pertain. The possibility of‘evidence-driven’ but context-free research disruptinglocal priorities and development processes must beavoided. When there is limited formal health literature onthe subject of enquiry, it does not necessarily imply anabsence of ideas and experience on it. Frequently, discus-sions relevant to health policy and systems issues can be

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found in the literatures of related fields such as the social,policy and organisational sciences and sector-specificstudies other than health, as well as in the media and incommunities. Researchers can enhance the relevance oftheir findings by referencing discourses that lie outsidethe formal research literature (Case study 3). HPSR has anactive place for descriptive and exploratory research,accessing such alternate discourses and unearthing tacitknowledge, especially in settings that are poorly exploredand understood, such as in many low- and middle-incomecountries [4].

Case study 3: Knowledge uptake for policy oncommunity participation for health in India. In2010, a high-level committee developing national recom-mendations on universal health coverage in India taskeda technical team of researchers with the synthesis ofevidence on community participation for health (CPH).In the following year, several ‘learning cycles’ took placeinvolving the committee and the technical team, untilrecommendations were developed [39].The technical team commenced with a structuredreview of the global peer-reviewed literature on CPH.When presented to the expert committee, some globalnorms and practices supported through research andadvocacy in high-impact journals, were felt to be debat-able when viewed in context in India. For instance, thequestion of ‘piece-rate’ or task-based incentives for front-line health workers [40], was deliberated. Discussionshighlighted that, in spite of advantages, relying on piece-rate payments could reinforce selective caregiving and amedicalized view of community health – at odds with thelong-term and comprehensive role of community healthchampion and mobilizer envisioned for India’s ASHAsin a universal health coverage milieu. The committeeeventually recommended a basic fixed emolumentsupplemented by limited performance incentives.Major evidence gaps also diminished the usefulness ofthe initial review, with its exclusive reliance on evidencefrom journals. For instance, formal evidence on thesignificance of decentralized governance for improvedcommunity health is scarce – yet the Panchayati Rajsystem of local self-governance is integral to the overallimpetus of social sector reforms in India, and hencefound a prominent place in the report.The technical team expanded the knowledge-base to in-clude first-hand consultations with informants from 20organizations engaged with CPH on the frontlines andreview of informal ‘grey’ reports of CPH interventions inIndia. Influenced by principles of realist synthesis [41]and analytic generalization [6], the technical team alsorefined their approach to analysing availableknowledge, focusing on delineating ‘mechanisms’that underpin successful interventions. Examples of

CPH mechanisms that passed the dual test of evidence-support and local credibility (as assessed by the expertcommittee) included NGO roles in training andstrengthening government-community relations; commu-nity health worker mentorship and support networks;and sustained financial and institutional support forcapacity building for CPH – these informed the eventualrecommendations. The knowledge uptake process,reflecting overlapping, iterative cycles of collaborativelearning, benefited from consistent dialogue between thecommittee and technical team.

ConclusionsWe have argued that the guiding principles of a people-centred and change-oriented practice of HPSR inherentlyentail understanding the human and people-defined attri-butes of health systems more closely (seeing), actively con-sidering the relationship of the researcher to the research(being), and working with an understanding of researchquality that embraces context and relevance (doing).We conclude by proposing a set of questions acrossthese three dimensions that health policy and systemsresearchers may wish to consider in making their prac-tice more people-centred, and hence more oriented to-ward real-world change:

Seeing: health systems with people at the core

� Does the research explicitly address dynamism andcomplexity, allowing for the social, political, andeconomic drivers of human behaviour?

� Have I situated the topic and findings in theirimmediate policy contexts, and in their broadersocial/political contexts?

� Does my research design advance understanding ofthe human attributes (choices, needs, preferences,interests, power, values, etc.) of the health system/policies in the setting of the research?

� Does my approach to the health system/healthpolicy allow for power, equity, and justice?

Being: considering the researcher’s position

� Have I considered my intentions for undertaking theresearch, and my position vis-à-vis the research subject?

� Have I explicated my own position vis-à-vis mypower, my influences, and my interests related tothe research, and my value basis, as indicatedby my philosophical position and the change Iwish to see?

� Have I engaged with other researchers investigatingthis theme? What do I contribute to, and gain frombeing part of, the community of health policy andsystems researchers?

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� How do I, as a researcher, engage with other healthpolicy and systems actors, on what terms and withwhat consequences for my research and for effectingchange in health policy and systems?

� Do I have autonomy in developing my own researchideas and conducting my research?

� Does my research hold a transformative intention,beyond informing the choices of designatedpolicymakers? Do I have a strategy for actualizingsuch transformative change?

Doing: relevant, high quality research

� Who is my research for? Who do I see as theprimary users of my research findings?

� How has my research been influenced, directly orindirectly, by the experiences and perspectives ofhealth system actors (including service users andcommunities)? Which health system actors? Have Iengaged, directly or indirectly, with any of them inthe process of defining my thematic focus andresearch questions, and while interpreting findings?

� Is my choice of research approach matched to theresearch question?

� Does my research design and analysis approachapply parameters of rigour and quality that areappropriate to the methodology used?

� (Especially if the subject/setting is previously poorlyexplored) Does my research design incorporate theexploration of non-formal publications and relevantsocial and political discourse pertaining to the setting(s)in which my research is likely to be utilized?

� Have I considered the consequences of theinterpretation or application of my research findingsin the settings in which they are likely to be used?Have I considered the intended and unintendedeffects on other social and policy agendas?

Competing interestsThe authors declare that they have no competing interests.

Authors’ contributionsKS, AG, and LG conceived of the article. KS wrote the first draft. KS, AG, andLG jointly revised the manuscript critically for important intellectual contentand gave final approval of the version to be published.

AcknowledgementsWe are grateful for comments received from Helen Schneider, IreneAgyepong, Krishna Hort, and John Porter in developing this paper andthankful to Vrinda Mehra for her inputs. Asha George is a member of theFuture Health Systems Consortium (http://www.futurehealthsystems.org)and Lucy Gilson is a member of the Consortium for Resilient and ResponsiveHealth Systems (RESYST) (http://resyst.lshtm.ac.uk). This document is anoutput partially funded by the UK Aid from the UK Department forInternational Development (DFID) for the benefit of low and middleincome countries. However, the views expressed and information containedin it are not necessarily those of or endorsed by DFID, which can acceptno responsibility for such views or information or for any reliance placedon them.

Author details1Public Health Foundation of India, ISID Campus, 4 Institutional Area, VasantKunj, New Delhi 110070, India. 2Johns Hopkins University Bloomberg Schoolof Public Health, 615 North Wolfe Street, Suite E-8146, Baltimore, MD 21205,USA. 3Department Global Health and Development, London School ofHygiene and Tropical Medicine, Health Policy and Systems Division, Schoolof Public Health and Family Medicine, University of Cape Town, HealthEconomics and Systems Analysis Group, Private Bag X3, Rondebosch 7701,South Africa.

Received: 6 November 2013 Accepted: 6 April 2014Published: 17 April 2014

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doi:10.1186/1478-4505-12-19Cite this article as: Sheikh et al.: People-centred science: strengtheningthe practice of health policy and systems research. Health Research Policyand Systems 2014 12:19.

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